Airway management: a patient with Madelung disease

This case study describes a 51-year-old, ASA physical status II Hispanic man who underwent liposuction to the anterior neck and resection of adipose tissue of the posterior neck. The patient was diagnosed with multiple symmetric lipomatosis, better known by its eponym, Madelung disease. This disease is characterized by abnormal adipose tissue growth primarily in the neck and shoulder regions. As a result of this pathology, a complete airway assessment was challenging. The patient's Mallampati classification was class III with visualization of the soft palate only. Other elements of a full assessment such as thyromental distance, sternomental distance, and tracheal orientation were impossible to evaluate because of the extreme circumferential girth of the adipose tissue in the neck. In addition, flexion and extension of the neck was limited by a minimum of 20 degrees because of the pathology. The patient was deemed as having a difficult airway, and an awake fiberoptic intubation was planned and used successfully. The subsequent surgical procedure progressed without incident, and the patient was transferred to a stepdown unit for monitoring of his airway postoperatively.